Provider Demographics
NPI:1982644209
Name:SANFILIPPO FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:SANFILIPPO FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFILIPPO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-933-9111
Mailing Address - Street 1:55 HIGHWAY 35
Mailing Address - Street 2:SUITE #1
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5918
Mailing Address - Country:US
Mailing Address - Phone:732-933-9111
Mailing Address - Fax:
Practice Address - Street 1:55 HIGHWAY 35 NORTH
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748
Practice Address - Country:US
Practice Address - Phone:732-933-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00481900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ054373Medicare ID - Type UnspecifiedMEDICARE GROUP#